Comprehensive Billing Report 202103

What is a CBR?

Comparative Billing Reports (CBRs) summarize Medicare claims data and distribute it to providers to provide insight into billing trends.  Each CBR is unique to a single provider and is only available to that individual provider. CBRs are not punitive and will not be publicly available.

What is the purpose of a CBR?

These reports can help providers proactively assess any areas of increased risk and/or vulnerability and support efforts to ensure compliance with Medicare payment policy and/or accurate coding.  Their purpose is to educate providers about vulnerable areas in the Medicare program and are meant to be a tool to encourage coding and billing guidance, education, and improvement activities.

What can your practice do if you received a CBR?

Ophthalmology Exam codes are vulnerable to improper payments typically because of insufficient documentation to support the eye exam code chosen.  It is important to review the documentation in the note and choose the code carefully.  A website has been established to assist providers who have received a CBR with information and resources to understand the report.

  1. Conduct an Internal or External audit of comprehensive eye codes to ensure you are not over-utilizing the code(s) and that the documentation in the chart supports the selected eye exam code.
  2. Address the CBR in your practice’s next scheduled compliance meeting.  The minutes of the meeting should include the following information:
    1. Acknowledge receipt of CBR
    2. Recommend Internal or External Audit
    3. Conduct Audit
    4. Include audit results
    5. Outline plan to address audit findings (i.e. employee/physician education on comprehensive eye code coding criteria, next scheduled audit, more frequent audits for a period of time to ensure proper coding, etc.)

To learn more about how PMRG can help with conducting audits and offering feedback and education for physicians and staff in your practice, contact us using the information below.


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